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Canada: Surgery procedures increase as outcomes improve

5,989 bariatric procedures performed in 2012–2013, up from 1,600 procedures in 2006–2007
Total cost for nearly 6,000 bariatric surgeries performed in 2012–2013 was approximately C$48 million
In 2012–2013, gastric bypass was the most commonly performed bariatric surgery in Canadian hospitals (53%), followed by sleeve gastrectomy (28%) and gastric banding (15%)

The number of bariatric surgeries performed in Canadian hospitals has nearly quadrupled since 2006–2007, according to a study from the Canadian Institute for Health Information (CIHI). At the same time, patient safety has improved with complication and readmission rates declining over the past few years with a readmission rates after bariatric surgery similar to that for all surgical patients in Canada.

“One in 5 Canadian adults has obesity and with those rates continuing to grow, so too will the need to understand the implications for the health care system,” said Kathleen Morris, director of Health System Analysis and Emerging Issues at CIHI. “Bariatric surgery can be effective to help some patients reach a healthy weight. However, it is not without risks. Supervised weight-management programs and lifestyle changes such as healthy diet and increased physical activity can be effective too.”

Report

The study, ‘Bariatric Surgery in Canada’, examines the current state of bariatric surgery in the country and reports the types of surgeries, costs and regional variations in surgery, as well as patient outcomes.

The report states that 5,989 bariatric surgeries were performed in 2012–2013, up from 1,600 procedures in 2006–2007. The rise is due largely to increased funding, surgical capacity and treatment programmes in some provinces, most notably Ontario.

Over the same period, the number of hospitals performing the procedures also grew, from 34 to 46. It is estimated 1,000 additional procedures were performed in private clinics across Canada in 2012 however, the report states that “Comprehensive data is not currently available on how many patients might be pursuing this option.”

In 2012–2013, most procedures took place in Ontario (2,846) and Quebec (1,988), with Ontario accounting for almost half (48%) of all hospital procedures done in Canada. From 2006–2007 to 2012–2013, procedures increased in the province from 297 to 2,846.

“Despite recent increases in funding in some jurisdictions, access to bariatric surgery remains a challenge in Canada,” the report states. “Expanding the guidelines for the surgery to potentially include those with less excess weight, such as individuals with class I obesity, may result in significantly more people being eligible for the surgery.”

The report estimates that the total cost for nearly 6,000 bariatric surgeries performed in 2012–2013 was approximately C$48 million (excluding physician compensation).

Patient characteristics

Although there have been significant changes in bariatric surgery volumes in recent years, the reort notes that patient characteristics have remained relatively consistent. In 2012–2013, 80% of hospital bariatric

surgery patients were women, reflecting the higher percentage of women among Canadians with class II (52%) and class III (60%) obesity.  The average age of patients was 45, ranging from 43 in Manitoba to 47 in British Columbia. The age distribution shows that almost six out of ten (56%) patients were age 30 to 49. The most common obesity-related comorbidities documented among bariatric patients in this study were sleep apnoea (15%); hypertension (14%) and type 2 diabetes (13%).

Surgical procedures

In 2012–2013, gastric bypass was the most commonly performed bariatric surgery in Canadian hospitals (53%), followed by sleeve gastrectomy (28%) and gastric banding (15%). Between 2006–2007 and 2009–2010, gastric banding and gastric bypass were the most common procedures.  However, gastric bypass and sleeve procedures have increased sharply since 2009–2010, while the overall number of other procedures (such as biliopancreatic diversion) has declined (Figure 1).

Figure 1: Changes in volume of different types of bariatric procedures performed in Canadian hospitals, 2006–2007 to 2012–2013

Complications

In 2012–2013, approximately 5.3% of bariatric surgery patients experienced a complication during their hospitalisation, a decrease from 8.2% in 2009–2010.

The most common complications were bleeding; puncture and laceration; infection; and mechanical complications of inserted devices as a result of displacement, leakage or perforation.

In 2012–2013, 14% of bariatric surgery patients who experienced in-hospital complications were readmitted to hospital within 30 days. In comparison, only 6% of patients who did not experience a complication were readmitted.

The declines in both in-hospital complication and readmission rates suggest that reducing in-hospital complication rates can potentially reduce the likelihood of readmission following bariatric surgery.

“There remains a great deal of variation across provinces in the specific procedures provided to patients and in how long patients wait to receive their surgery,” the report concluded. “More research is required to consider the impacts of government policy (such as coverage for band procedures), patient preference and physician practice patterns in ongoing efforts to improve access to and outcomes of publicly covered bariatric procedures.”

"We clearly will never have the capacity in Canada to help all of those who would qualify for bariatric surgery with bariatric surgery," said Dr Yoni Freedhoff, assistant professor of family medicine at the University of Ottawa and founder of Ottawa's Bariatric Medical Institute, a nutrition and weight management centre.  “Bariatric surgery, when performed on appropriate patients by skilled surgeons, and when supported by a robust and well-designed educational component that helps support a healthy post-surgical lifestyle—increases life expectancy, decreases or cures many medical comorbidities and improves many other aspects of quality of life.”

To view the report, please click here

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